The Politics of Natural Cycle IVF

Yesterday we discussed two major issues facing patients and their doctors: How do we completely avoid the temptation to transfer more than one embryo and also avoid the risk of OHSS completely? One answer was to use Natural Cycle IVF.

Why then would all clinics not offer Natural Cycle IVF? The procedure is already proven and familiar. We all do egg collections. We can use ICSI to ensure fertilization occurs if there is any concern. We all culture embryos. So where’s the problem?

Here’s the situation as I see it. According to the Wyden Law every fertility clinic in the US must submit its statistics to the CDC so that they can be made available to the general public. The CDC emphatically states that consumers should not use these tables to compare clinics because practice patterns can vary between clinics and physicians…yadda, yadda.

Of course, the reality is that most patients use these statistics to directly compare clinics eventhough the old adage of “there are lies, damn lies and statistics” always holds true. Honestly, if you really want to compare clinics and eliminate the influence of patient selection then look at their donor egg IVF pregnancy rates (ours is 127%) since donor egg IVF would represent a “level playing field.”

So back to Natural Cycle IVF….we believe that the best candidates for Natural Cycle IVF are patients <35 years old with a well defined fertility problem (tubal blockage, male factor, endometriosis). In these patients Natural Cycle IVF can be successful with very good pregnancy rates (although the per cycle pregnancy rates will be about 1/3 of the stimulated cycle pregnancy rates). But guess what? This patient population also represents the best candidates for stimulated cycle IVF.

Now every year I am asked to submit my statistics for my IVF program to the CDC. On each patient’s data entry form the CDC asks if this is a stimulated or unstimulated (Natural Cycle) IVF cycle. Then they ignore this piece of information and lump all the IVF cycles together to yield the tables that patients then look at when choosing clinics.

So if I am an RE trying to make a practice decision concerning Natural Cycle IVF, then I need to think carefully about the implications of this decision. I can offer Natural Cycle IVF, which is less expensive and more patient friendly, BUT as a result I will siphon off some of my best stimulated cycle IVF prospective patients into a program that will also yield lower per cycle pregnancy rates. The end result is that I will be shooting myself in the foot in terms of my CDC IVF stats that patients love to use to compare clinics….Hmmm let me give that a great deal of thought. Guess what most clinics in the US decide…

However, I do have a solution that would determine if my assessment is correct. What I have suggested to the CDC is the following: since they already ask us to delineate between stimulated and unstimulated IVF cycles, why not publish the stimulated cycle IVF pregnancy rates and unstimulated IVF pregnancy rates as separate sets of tables? 

Currently only a few clinics offer unstimulated IVF. I predict that number would rise dramatically if the disincentive to offer Natural Cycle IVF was removed. I may be wrong on this point but I don’t think that I am…

So if you are interested in encouraging the CDC to change their approach just let me know and I will tell you who to send a letter to….hey, if we could save Star Trek in 1966, certainly we can get Natural Cycle IVF into the mainstream.